Advice for New Charge Nurse

[CandyApple26]

I have been a charge nurse for a few months off and on, but recently have been thrown into the role full time. I am a young nurse (I am the youngest on the floor) and often feel taken advantaged of by my fellow co-workers. I also am not being received well by my co-workers and do not know how to talk to them because they often get defensive and rude.

My main problems are them asking me to do things for them because they did not manage their time well (starting an IV or because they want to take a break (unknown to me), getting an attitude when asked to do something or when I am too busy to complete a task for them, wanting me to change things to the day shift schedule that night shift made, after report has already started, throwing the fact that I am the charge nurse in my face ("Since you are the charge nurse, you need to take care of this" (i.e. things they could easily take care of like calling maintenance to get a toilet fixed, or "well you are the charge nurse, I thought I should be able to come to you"(like I haven't been asking them all day if they are okay)), lying to me about my responsibilities, asking me to start IV's when they haven't even tried, and interrupting me when I'm talking to someone else or on the phone (Especially with a physician) to ask me to do something or to tell me something that needs to be done. They also tell the other nurse they ask for help "Well, I asked her, but she is too busy to help me."

Some things I realize I am just going to have to deal with, but I am trying to seek their approval. If I say no or get firm with someone (not necessarily raising my voice), it often gets taken as being disrespectful. I feel like they are walking all over me and I don't know how to stop them from doing it. I do not see them do this to the other charge nurse and I don't see the other charge nurse checking up on everyone either and going out of her way to do things like feed patients, take vitals for the techs when we are shorthanded, pull patients up in bed, help clean up patients, answer call bells, or grab someone's med rec's and offer support when someone's patient is going bad. I am not trying to put anyone down, but I really do not want to be unhelpful. It is really starting to take a toll on me stress wise and I wanted some other charge nurse to charge nurse advice. I don't want these other nurses to turn against me, but at the same time, I don't want them to expect me to do their work for them.

[I<3H2O, BSN, RN]

I wish I had some advice for you that would help you out. Without knowing you specifically and the unit you work on, I struggle to give advice to you. With saying that, what are you duties as the charge nurse? On my unit, the charge nurse is expected to do the admits and dismissal paperwork, make rounds with the physicians, cover our pts when we take a break (ha ha), go to the codes on other units, be an "experienced" ear to listen when we need another nurses opinion, to make room assignments, and to note all of the new orders (including verifying med orders). There is no job detail that says that these things are to be done by the CN but I believe as a general rule, these things are expected as the CN does not take patients during the day shift.

When someone asks you to do the things that annoy you, call them on it. You do not have to be rude or ugly but you can simply say, "where have you tried to start the IV?" or "Have you tried?" or maybe even "have you applied warm packs so that there might be something to stick when I get there?" If you are truly sitting with nothing to do, then maybe you should go start that IV, this may be the ONLY thing keeping them from taking a break and they need one.

What would you really like for your CN to do for you when you are busy? Ideally, the CN should be able to help out enough that unless there is some extenuating circumstances, everyone should be able to leave together. It is called TEAM work.

We have a few CNs on my unit that do nothing more than make sure they get their breaks, do an occassional round with a physician, and note orders. While noting orders is helpful, so is starting that IV so that I can get a quick break in before I have to hang blood, pull clots from a CBI, or take q2h FSBS.

[tokmom, BSN, RN]

Welcome to the trenches. I feel your pain and could have written your post.

What specifically are your duties? I do admits, discharges, med recs, put our fires, answer call lights, go to meetings, etc. Thankfully I don't check off new orders like the other poster mentioned. I have enough to do!

I wish I had some answers for you. It's a fine line we have to walk and one that doesn't make any sense to me. I know many times a CN gets more respect if she forgets her own duties and caters to the nurses on the floor. I know they are busy, and I know it get's crazy, but I have my own duties to do first, or I get behind and have patients angry at me. One day I was pulled into rooms 15 times to co sign. To top it off, the vast majority didn't even have the pt scanned!

At first I wanted to be there for everyone, but got to the point to tell them to try to start their own IV first, or place the foley. They will never get good at doing these tasks if they don't try. I also tell them to have the co sign box up so I can get in and out. I don't want to see you fumble through your screens.

Another CN I work with really layed down the law with the nurses. She won't do admits, co sign or drop what she is doing. Guess, what? She isn't any less respected because of it.

In your case, you might want to take some conflict managment class, and talk to your NM on what to do. A CN position was new to our facility and it took the backing up the NM to get the staff to listen to us.

In the meantime, be fair, consistent and limit set. If they want you to call maintence, etc..refer them to the secretary. After awhile they will get the message.

[merlee]

Stop trying to please people, you are in charge, not there to be everyone's friend. You need to say 'no', redirect their efforts when necessary.

I like some of the previous comments - 'where have you tried to start the IV?' Is there a problem placing the catheter? Good questions!

Don't let passive-agressive comments get you off track.

Best wishes!!

[Guest717236]

Set limits! Know your job description. Define your expectations and

expect your staff to report appropriately to you. They are most

likely "testing" you. Be clear and assertive. When their toddler type behavior

subsides, show them you are fair and willing to be available when appropriate

as a resource nurse, not someone who will have their workload transferred

to you. Make sure they work as a team, helping each other.

The best charge nurses I have worked with have been peers who have

been leaders and educators.

Once you clearly set expectations and limits, my prediction is

the atmosphere will change.

[CandyApple26]

Thank you guys! We are in charge of audits (infection control, restraints, telephone orders and if a nurse notes orders, SCD, narc, etc.), making sure the the fridges are clean and the right temperatures, discharge calls, going to get supplies if supplies are needed and are not stocked, and being there to help when needed. We do not note orders unless they are our own patients so that the nurse whose patient it is knows what is going on with his or her patients. We are a 45 bed unit with a full census all of the time. Each nurse runs with 5-6 patients during the day (so that's 8-9 nurses).

I

Thank you guys for your advice. I will be sure to take it =)

[canesdukegirl, BSN, RN]

Hey Candy,

I understand your frustrations. It is difficult to acclimate from being a staff nurse to being a charge nurse.

When I first became a charge nurse, I found that my biggest challenge was my inherent need to please EVERYONE. I would knock myself out to ensure that everyone was happy. The day that Mr. Reality knocked on my door and whispered, "Hey, Canes...yeah, you! You can't keep doing this! You are making yourself sick trying to do the impossible!" was the day that I learned how to DELEGATE.

I read a book from Amazon.com called 'A Charge Nurses' Guide: Navigating the Path of Leadership'. It helped me tremendously.

[79Tango]

There's a fine line with being someone's buddy and being their boss & heck yeah they are testing you. Canes said it very well--DELEGATE, DELEGATE, DELEGATE or you'll make yourself crazy. Give these people some rope and if they choose to hang themselves-- let them. Just CYA and make sure your patients are safe. These people are not dumb, they dont want to jepordize their jobs and licenses.. They just want to get bye as easy as possible.

[mnbrn]

Doing Charge is tough.

On a typical day,

I have my own assignment of 3-4 adults (and sometimes a baby or two added to that), which includes hourly rounding.

I round with the docs.

Do staffing (deal with various depts and people on this).

Assign beds for admits.

Resource the other nurses.

Put out 'fires'. Attend to pt complaints, etc.

Do discharge phone calls (or divide them up between everyone).

Do 'leadership rounding' on all pts on the floor.

Go to meetings.

Check med room for discrepencies.

Make out assignments, decide who admits which pt.

Orient a new nurse.

Set the tone. Be positive, helpful, assertive.

Everyone has their own style. I am laid back in nature. I tend to keep everyone in the loop in what's going on, include them. I'm open to suggestions. I delegate when I can. I try to deal with what needs done while staying calm and positive.

You'll find your own style and what works for you!